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U.S. Leads in Sexually Transmitted Disease Rate

Deaths, disabilities three times higher than other developed nations, study finds

WEDNESDAY, Jan. 26, 2005 (HealthDay News) -- Rates of early death and disability that can be attributed to sexual behavior are three times higher in the United States than other so-called developed nations, a new study finds.

This finding precludes the AIDS epidemic in many African countries.

American men still die more often as a result of having a sexually transmitted disease, researchers from the U.S. Centers for Disease Control and Prevention said, but more cases are reported in American women. The findings were published in the Jan. 27 issue of the British journal Sexually Transmitted Infections.

"It certainly is disturbing," said Dr. Cynthia Krause, assistant clinical professor of obstetrics/gynecology at Mount Sinai School of Medicine in New York City. "The challenge is how to represent this in a way that's not alarmist, to make women aware of the real risks."

An earlier survey had found that half of all deaths in the United States in 1990 were attributable to nine risk factors that included sexual behavior. That category alone accounted for 30,000 deaths. The researchers behind the new study didn't think this provided a complete picture of the health toll, given that sexually transmitted diseases are associated with other problems such as infertility, psychological trauma and stigma.

They set out to quantify the public health burden of sexually transmitted diseases in 1998 by looking at national data on sexual health and reproduction, surveillance systems for infectious diseases, hospital and outpatient statistics, birth and death records as well as published research.

They then calculated "adverse health consequences," such as infertility, cervical cancer, and HIV infections. They also factored in premature deaths and "disability adjusted life years" (DALYs), a figure indicating years of life cut short by premature death and loss of healthy living years as a result of disability.

In 1998, sexual behavior accounted for about 20 million "adverse health consequences" (equivalent to more than 7,500 per 100,000 people) and 29,782 deaths (or 1.3 percent of all deaths in the United States), the study found.

Sixty-two percent of the "adverse health consequences" and 57 percent of "disability adjusted life years" were among women. Curable infections and their consequences accounted for more than half of these health problems. Viral infections -- mostly HIV/AIDS -- and their consequences accounted for almost all deaths among men and women.

In terms of percentages, more men (66 percent) than women died due to sexually transmitted diseases. But if HIV/AIDS were not considered, then 89 percent of deaths attributed to sexual behavior would have been among women.

HIV/AIDS was the leading cause of death among men, while cervical cancer and HIV/AIDS were the leading causes of death among women.

These estimates are probably conservative, the authors stated.

The study did not address why the United States was hit so hard by sexually transmitted diseases, although the study's lead author, Dr. Shahul Ebrahim, said that behavior was only part of the equation.

"Everybody is having sex in the world, but some places have a low HIV prevalence," said Ebrahim, who is a medical epidemiologist with the CDC's National Center for Birth Defects. "Behavior is just one indicator. Another issue is transmission risk factors."

Researchers are planning to use the data to increase the public's awareness of the problem.

"The two most important issues are HIV and cervical cancer [which can occur from having numerous sexual partners]," Ebrahim said. "For cervical cancer, we have a national program to screen all women of a certain age group and risk, but not everybody is accessing that. We've reached the 80 percent mark but we still have 20 percent remaining."

A similar problem exists for HIV. "Not everybody is getting tested for HIV. Once you get tested, you can access treatment and probably prolong life," Ebrahim said.

None of this is going to happen overnight, he added. The consequences of "sexual behavior are totally preventable," he said. "If you have protected or safe sex, you are not going to have these."

More information

The CDC has more on sexually transmitted diseases.

SOURCES: Shahul Ebrahim, M.D., medical epidemiologist, National Center for Birth Defects, U.S. Centers for Disease Control and Prevention, Atlanta; Cynthia Krause, M.D., assistant clinical professor of obstetrics/gynecology, Mount Sinai School of Medicine, New York City; Jan. 27, 2005, Sexually Transmitted Infections
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